Autonomic pain is a type of nerve pain that arises due to abnormalities in the function of the autonomic nervous system. With autonomic pain, an abnormality in a group of nerves called a ganglion causes pain to an organ or body region. To treat autonomic-mediated pain physicians can block a ganglion with the injection or application of medication to a specific area of the body. To therapeutically treat acute pain a physician injects or applies a local anesthetic to the affected neuronal ganglion. This type of treatment may be referred to as a nerve block.
In 1908 Greenfield Sluder M D, published his article, “The role of the sphenopalitine ganglion in nasal headaches,” in the New York Medical Journal. He advocated using a long needle through the side of the face to inject cocaine into the sphenopalatine ganglion (SPG) to treat certain severe recurrent headaches. More than a century of medical science has validated Sluder's basic premise: that sphenopalitine ganglion blockade (SPGB) is a valuable tool in headache management.
The SPG is a collection of nerve cells resting just beneath the thin tissues that line the back of the nasal passage. Because of the neural connections that pass through it, the SPG plays an essential role in various types of headaches. Temporary interruption of impulse conduction through the SPG can often abort headaches and sometimes provide long-term relief to headache sufferers.
Other conditions shown to respond to SPGB in published literature include: trigeminal neuralgia, dental pain, post-partum neck and back pain, complex regional pain syndrome, herpes zoster (Shingles), tempromandibular joint (TMJ) pain and primary hyperhydrosis.
Aside from the personal pain suffered by those who experience recurrent severe headaches, the staggering financial cost to society is difficult to estimate or comprehend. Just for the 30 million migraine sufferers in the United States, annual direct medical costs are estimated to exceed $12B, with lost productivity costing employers an additional $12B. Those figures do not include the rest of the world or the two dozen other types of cephalgia found in the World Health Organization's headache classification scheme.
An estimated 4-5% of the population suffers from chronic daily headaches which, by definition, impact a person's ability to function for at least 15 days a month for at least 3 months. Of those patients, 30% are managed with relatively inexpensive medications; 17% require pharmacologic regimens exceeding $500/month; and more than half continue to suffer a virtual failure of modern medicine.
Any intervention that reduces the incidence or duration of headaches has the potential to dramatically reduce personal suffering and to save patients, insurance companies and governments enormous sums of money. The SphenoCath™ brand of catheter system offers a simple, safe, inexpensive intervention, as explained herein and claimed below.
The SPG/pterygopalatine ganglia is a neuronal structure located principally in the center of the head in the pterygopalatine fossa posterior to the middle turbinate. The sphenopalatine/pterygopalatine ganglia comprises the largest cluster of sympathetic neurons in the head outside of the brain. The sphenopalatine/pterygopalatine ganglia interfaces and directs nerve impulses to the majority of the head's autonomic or parasympathetic pathways. Therefore, any abnormality or injury to this structure may cause severe pain. A nerve block of the sphenopalatine/pterygopalatine ganglia may relieve a variety of painful conditions ranging from headache to lower back pain. Additionally, other disease processes such as headache disorders and other neurological conditions can be arrested, or improved by local anesthetic blockade, and/or other pharmacological augmentation or mechanical alteration of the sphenopalatine/pterygopalatine ganglia and surrounding structures.
Unfortunately, because of the anatomical position of the SPG/pterygopalatine ganglia, the structure is very difficult to block with a local anesthetic solution. The anatomical location of the sphenopalatine/pterygopalatine ganglia is dangerously close to many vital and delicate mid brain structures. Although direct needle placement can be employed under fluoroscopic guidance to administer anesthetic to the sphenopalatine/pterygopalatine ganglia, most practitioners will not attempt the procedure due to the technical difficulty and extreme dangers of an aberrant needle placement.
Accessing the SPG/pterygopalatine recess to treat the SPG/pterygopalatine ganglia with a conventional device is difficult in that a conventional devices typically do not include a curvature for accessing the sphenopalatine/pterygopalatine recess. Further, even if a conventional needle were curved to access the sphenopalatine/pterygopalatine recess, once the curved needle were inserted into the patient's nasal cavity, the physician or other medical professional would not be able to identify the direction of the curve of the needle. Without fluoroscopic guidance, an insertion end of the needle may contact and/or damage the vital and delicate mid brain structures. To date, this limitation has limited both service-providers and patients from being involved to a large extent.